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Emergency and First Aid Nursing

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on 13 November 2013

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Transcript of Emergency and First Aid Nursing

Emergency and First Aid Nursing
Bleeding and Hemorrhage
Types of bleeding
Shock
The abnormal condition of inadequate blood flow to the body's peripheral tissues.
Choking
CPR
Best to initiate within first 3-5 minutes
Adult CPR
Hypovolemic Shock
AKA: Hemorrhagic shock. Caused by decrease in in fluid volume from bleeding, prolonged vomiting and diarrhea, or by loss of fluid during surgery, trauma or burns.
Cardiogenic Shock
Results from poor heart function caused by various cardiovascular abnormalities. Heart is unable to maintain sufficient blood pressure to all body parts
Assessment of the Emergency Situation

Asses life threatening problems first: A, B, C's
Observe for signs of Brain or spinal cord injury
observe for signs of internal/ external bleeding
Attend fractures, dislocations, and other wounds after treating more serious conditions.

Initial Assessment and Response
1. Determine need for CPR: Shake victim, shout "are you ok", shout for activation of emergency response system.
2. Check for breathing
3. Check for pulse
4. begin CPR
Good Samaritan Law
Legal stipulation for protection of those wo give first aid in an emergency situation.
Obtain consent, victim has right to refuse.
Law assumes consent for unconscious victims.
After you initiate first aid, you must continue until help arrives.
Ethical Considerations
Reasons individuals do not become involved in CPR: Lack of Motivation, fear of doing harm, lack of knowledge, and fear of contracting communicable disease.

If you do initiate CPR DO NOT STOP unless;
The victim recovers
The rescuer is exhausted and cannot continue
Trained medical personnel arrive on the scene and take over
A licensed physician arrives and pronounces the victim dead, and orders CPR to cease.
Pediatric and Infant CPR
Anaphylactic Shock
Results from sudden and severe allergic reaction.
Neurogenic shock
Caused by nervous system failure to maintain normal contraction of blood vessels
Common causes: Spinal anesthesia, med that causes vasodilation
Psychogenic Shock Syncope
Caused by the nervous system's response to an emotional stimulus.
Blood vessles temporarily dilate decreasing blood flow to the brain causeing syncope.
Septic Shock
Results from severs infection.
Common in pts receiving chemo or in conditions that result in immunodeficiency
Venous

Venous: slow, even flow of dark red blood.
Risk for entrance of air into the severed vein , which can create an air embolism.
Air embolism can become lodged in a blood vessel traveling to vital organs.
Atrial
Least common
Heavy spurting of bright red blood in rhythm of the heart beat.
Most common affected arteries: Femoral, radial, brachial, carotid.
Nursing Interventions
Direct pressure, and elevation
If direct pressure does not work then indirect pressure maybe be needed. (tourniquet)
Epistaxis
Keep client calm, in sitting position, leaning forward
Apply direct pressure to both nostrils for 10-15 minutes
Ice may be applied to nose as well to aid in stopping blood.
Epistaxis digitorum
Internal Bleeding

If internal bleeding is suspected, place victim on flat surface with feet slightly elevated, and apply cold compress to suspected area of injury.
Wounds and Trauma
ABC's of wounds:
1. Stop Bleeding
2. Treat for Shock
3. Prevent Infection
Open vs Closed wounds
Closed Wounds
Involves underlying tissues of the body, top layer of skin is intact.
Ecchymoses(Bruises), contusions
Assess for signs of internal bleeding
Open Wounds
Opening or breaks in the mucous membranes or skin. Tetanus injection is usually necessary as a general treatment for all open wounds.
Abrasion
Caused by rubbing or scratching
Nx interventions:
Remove all dirt
Do not use strong antiseptic
Clean wound from inside out
Cover with sterile dressing
teach pt S/S of infection
Puncture Wound
Piercing wounds of the skin. typically by nails, knives, wood, glass or other objects.

Nursing Interventions:
Irrigate thoroughly
Tetanus booster
Cover with sterile dressing.
Laceration
Torn, with jagged irregular edges. Typical in Auto accidents, blunt objects, and machinery accidents.

Nx Interventions:
Carefully clean, and control bleeding.
use adhesive strips or butterfly bandages.
Cover with sterile Dressing.



Incisions
Smoothly divided wounds made by sharp instruments.

Nx Interventions:
carefully clean
cover with sterile dressing
Avulsions
Torn piece of tissue that results in a section being completely removed or left hanging by a flap.

Nx Interventions:
Control bleeding
sutures
closely monitor healing process.
Chest wounds
Extremely dangerous.
Risk for Pneumothorax: air entering the pleural space.
Hemothorax: Blood entering pleural space.
Assessment of Pneumothorax

Sharp pain at site of injury
Pain associated with breathing
difficult and labored breathing
Asymmetrical chest expansion
bright red frothy blood
A sucking or hissing sound as air flows in and out of chest.

Nx interventions: Do not remove object if source of injury. elevate victims head slightly, apply air tight dressing if a sucking sound is heard.
Application of bandages
Bandage Compress
Most common
Consist of several thicknesses of gauze, covered with tape or gauze.
Triangular Bandage
Made of a piece of cloth that is folded diagonally and cut along fold.
Commonly used to support injuries of the bone.
With sprain injuries remember RICE
Gauze Roller Bandage
Used to support an injured part, apply pressure to a dressing for control of bleeding or secure splint to immobilize a part.
Poisons
Each year thousands of people die from self-inflicted or accidental poisonings.
Majority are Children
Poisons include: Ingested, inhaled, absorbed, injected, drugs and alcohol.
If suspected ingestion or contact of ANY poison is present. CALL POISON CONTROL FIRST!!!
Bee Stings & snake bites
BUZZZZzzzzzzz
If individual has been stung by a bee, remove the stinger with the SIDE of a knife or credit card in a scraping motion.
Grasping Stinger could force venom further into skin.
Nx Interventions:
Wash with soap and water, apply cold packs, a paste of baking soda and water sometimes releaves pruritis.
Snake bite (venomous)
Have victim lie in supine position, with legs elevated.
immobilize affected area, remove jewelry.
Apply wide 4-5 inch constricting band proximal to the wound.
Check circulation of affected limb, keep below level of the heart.
Get victim to hospital IMMEDIATELY
Thermal and Cold Emergencies
Thermal
Heat exhaustion: Most common.
S/S: Headache, vertigo, nausea, weakness, confusion, cool clammy skin.
Heatstroke:
S/S: pulse rapid then slows, breathing deep and rapid, headache, dry mouth, N/V, muscle twitching and convulsions


Interventions:
Cool patient off quickly
place in supine with feet slightly elevated.
Cold Injuries
Hypothermia: Body temp lower than 95 F
Assess: everything slows down, patient may lose consciousness and appear dead.
Interventions: Initiate CPR, Supine with feet elevated, cover with warm blankets, warm IV fluids.

Frostbite: local cold injury involving freezing and damaging of body cells.
Assess: initially red and flush, progressively becomes hard and loses sensation may turn grayish white, edema and blisters may appear.
Interventions: Immerse affected part in warm water (104-110) for 20-45 minutes, do not allow water to cool.
Never place near open flame or oven.
Prioritizing Injuries
Triage: Process of classifying a group of patients according to the severity of injury and need for care.
Primary care are A, B, C's
Life threatening injuries
(RED)

Pt's who require treatment but injuries are not life threatening.
(Yellow)
Local injuries who can wait several hours before being treated.
(Green)


Some pts cannot be saved and they are tagged as
black.

Critical thinking
The nurse is answering a patient’s call light. When the nurse enters the room, she notices a woman lying on the floor. The patient informs the nurse the visitor was standing near the bedside table and suddenly collapsed, hitting her head on the bedside table. How should the nurse proceed with this situation?


Guidelines: The nurse should call out for help while assessing the visitor for breathing and then head and neck trauma. If the visitor is breathing, the nurse should leave the visitor lying flat since it is suspected the visitor has a possible head and neck injury. The nurse should assess for a pulse. If the visitor has a pulse, the nurse should stay with the visitor while waiting for help to arrive.
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